title: Motorised two-wheeler crash and helmets: injury patterns, severity, mortality and the consequence of gender bias.
abstract: BACKGROUND
  India records the maximum number of deaths from motorised two-wheeler vehicle (MTV) accidents in the world with mandatory helmet laws for males but not females. This study was designed to investigate injury patterns, severity, mortality, and helmet usage among hospital admitted victims of a MTV crash with a paired subgroup analyses on female victims.
  
  
  METHODS
  Hospital trauma registry from January 2011 to July 2012 for all adult victims of a MTV crash was analysed for outcomes of mortality, serious head injury, severe facial injury, and cervical spine injury while adjusting for age, gender, use of alcohol/drugs, injury severity score, and presence of shock by multivariable logistic regression model. Groups of helmeted victims (HV) and nonhelmeted victims (NHV) were identified.
  
  
  RESULTS
  A total of 2,718 victims were included. HV suffered maximum injuries to the lower extremity (29.04 %) and had reduced adjusted odds of death (odds ratio (OR) 0.65; 95 % confidence interval (CI) 0.48-0.86), serious head injury (OR 0.34; CI 0.26-0.45), cervical spine injury (OR 0.74; CI 0.54-1.06), and serious facial injury (OR 0.87; CI 0.57-1.26) compared with NHV who suffered maximum injuries to the head (24.49 %). Compliance with helmet use was 52.91 and 7.94 % among males and females respectively. A total of 224 pairs of male driver and female pillion involved in same MTV crash were identified, and the predominantly helmeted male had reduced odds of death (OR 0.44; CI 0.21-0.84) and severe head injury (OR 0.42; CI 0.24-0.72) compared with overwhelmingly nonhelmeted females.
  
  
  CONCLUSIONS
  Helmet laws must be strictly enforced, and society should think about the cost being born by its fairer counterpart by the gender-based differential law.
authors.affiliation: Department of Surgical Disciplines, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India, amitguptaaiims@gmail.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Jiten
authors.initials: J
authors.lastname: Jaipuria
authors.forename: Amit
authors.initials: A
authors.lastname: Bagdia
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.forename: Sushma
authors.initials: S
authors.lastname: Sagar
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Misra
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D015601:Injury Severity Score; D008297:Male; D009049:Motorcycles / Q000331:legislation & jurisprudence*; D019838:Neck Injuries / Q000453:epidemiology* / Q000401:mortality; D063507:Sexism; D013124:Spinal Injuries / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult